Deep Breathing Techniques to Help Manage Chronic Pain

Stress can increase inflammation in the body, which worsens chronic pain. Stress also increases the perception of pain. Deep breathing exercises help reduce stress and promote relaxation, which, in turn, reduces pain. Practicing deep breathing techniques can be especially helpful for individuals with chronic pain; when pain flares up, individuals tend to hold their breath or take fast, shallow breaths, which increases anxiety and pain levels.

What is deep breathing (diaphragmatic breathing)?

Deep breathing involves taking deep breaths from the diaphragm (the primary breathing muscle) rather than taking shallow breaths from the chest (a secondary breathing muscle). Deep breathing involves slowly inhaling through the nose while the belly expands, holding for a few seconds, and slowly exhaling through the mouth while the belly deflates.

When beginning the practice of deep breathing, it’s easier to identify if the belly is expanding and deflating from a reclined position. One hand should be placed on the abdomen and one hand on the chest. The hand on the abdomen should move up while inhaling and down while exhaling. The hand on the chest should stay still. When the practice becomes second nature, deep breathing can be done in any position (i.e., standing, sitting, etc.) without others even noticing.

Examples of deep breathing techniques that may be beneficial for individuals with chronic pain include 4-7-8 breathing, foursquare breathing, and equal breathing. Although these techniques are very similar, there are slight differences among them.

• 4-7-8 breathing
  This breathing technique involves inhaling through the nose for a count of four, holding the breath for a count of seven, and exhaling through the mouth for a count of eight. Beginners should start with four breath cycles in one sitting. As the body becomes more accustomed to deep breathing, up to eight cycles can be done in one session.
• Box, square, or foursquare breathing
  This breathing technique is similar to 4-7-8 breathing, but it also includes holding the breath after exhaling. Box breathing involves slowly inhaling through the nose for a count of four, holding the breath for another count of four, slowly exhaling through the mouth for a count of four, and holding the breath for another count of four. These four steps should be completed four times in one sitting. As the body becomes accustomed to the practice, it can be practiced multiple times per day.
• Equal breathing
  During this deep breathing technique, each inhale is the same length as each exhale. It involves inhaling while slowly counting to four, then exhaling while counting to four at the same speed. Individuals tend to speed up counting while exhaling, so it is important to exhale for the same length of time as the inhale.

Deep breathing may feel peculiar at first. Dizziness may occur until the body becomes accustomed to the technique. Practicing deep breathing in a quiet, dimly lit environment provides the best results. Although this is not necessary, focus is more easily maintained in this setting, especially when new to the practice. As the body becomes accustomed to deep breathing, practicing it for ten minutes three times per day for at least two weeks may help reduce pain.